Snapshot A 28-year-old male was hit by a car while crossing the road. He sustained abrasions to the face, hands, and bruising over both iliac crests. Blood pressure is 90/55 mmHg and pulse is 110/min. Two large bore IVs are inserted and he was given 1L of Lactated Ringer's, and 2L of crossmatched pRBCs. Scrotal and perineal ecchymosis and swelling, blood at the urethral meatus, and bladder distension up to the umbilicus are present. AP radiographs of the pelvis reveal pelvic fracture (bilateral pubic rami fracture). Retrograde cystourethrogram shows a torn posterior urethra; a suprapubic catheter and a pelvic binder are applied. Introduction Genitourinary trauma involves kidney, bladder, and/or urethra 80% is from blunt trauma (MVCs, assaults, falls, crush) vs 20% penetrating (GSW/SW) Blunt trauma to genitourinary organs is associated with pelvic fracture in 97% cases Urethral injury etiology can be divided by posterior and anterior urethra login to view 4 more bullets Presentation History login to view 5 more bullets Physical exam login to view 13 more bullets Evaluation Pelvis: radiograph with AP, inlet, and outlet views Urethra: retrograde urethrogram (RUG) login to view 1 more bullet Bladder: urinalysis, urethrogram, retrograde cystoscopy +/- cystogram Ureter: retrograde ureterogram Kidney: intravenous pyelogram, CT scan (if hemodynamically stable) Treatment Primary and secondary survey with resuscitation (massive transfusion protocol for hemodynamically unstable patients Pelvis: mechanical stabilization of pelvis login to view 12 more bullets Urethra: based on location of tear seen on retrograde urethrogram login to view 3 more bullets Bladder: based on extra vs intraperitoneal rupture login to view 5 more bullets Ureter: ureterouretostomy Kidney: depends on grade of hematoma / laceration and HD stability login to view 2 more bullets